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ABLATION OF BARRETT’S OESOPHAGUS: THE GOOD AND BAD NEWS
With the rising incidence of adenocarcinoma of the oesophagus, a method of eliminating Barrett’s oesophagus would be a step forward. The authors randomised 35 patients with Barrett’s oesophagus to ablative treatment with either multipolar electrocoagulation or argon beam coagulation. The good news is that both treatments eliminated Barrett’s oesophagus at 2 years in approximately 70% of patients, with neither treatment showing any statistical advantage over the other. Adverse events and outcomes were rare. Unfortunately it was not possible to identify risk factors for treatment failure. The bad news is that ablative treatment does not eliminate the need for surveillance as ablation is incomplete in 30% of patients. Repeated biopsies are required of the previous Barrett’s area to identify these treatment failures. Furthermore, it is still unknown whether such ablative treatment reduces the risk of subsequent adenocarcinoma. The authors conclude ablative treatment is not yet ready for clinical practice except as palliation for high grade dysplasia or frank cancer in patients unfit for surgery.
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Endoscopic view of the typical coagulation necrosis seen after ablation therapy with argon plasma coagulation.
INTESTINAL SECRETION OF FOOD ANTIBODIES IN RHEUMATOID ARTHRITIS
Previous authors have suggested that rheumatoid arthritis might involve an abnormal immune reaction to food antigens, but they have assessed serum immunoglobulins. …
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